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Gaalema DE, Khadanga S, Pack QR. Clinical challenges facing patient participation in cardiac rehabilitation: cigarette smoking. Expert Rev Cardiovasc Ther 2023; 21:733-745. [PMID: 37938825 DOI: 10.1080/14779072.2023.2282026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/07/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is highly effective at reducing morbidity and mortality. However, CR is underutilized, and adherence remains challenging. In no group is CR attendance more challenging than among patients who smoke. Despite being more likely to be referred to CR, they are less likely to enroll, and much more likely to drop out. CR programs generally do not optimally engage and treat those who smoke, but this population is critical to engage given the high-risk nature of continued smoking in those with cardiovascular disease. AREAS COVERED This review covers four areas relating to CR in those who smoke. First, we review the evidence of the association between smoking and lack of participation in CR. Second, we examine how smoking has historically been identified in this population and propose objective screening measures for all patients. Third, we discuss the optimal treatment of smoking within CR. Fourth, we review select populations within those who smoke (those with lower-socioeconomic status, females) that require additional research and attention. EXPERT OPINION Smoking poses a challenge on multiple fronts, being a significant predictor of future morbidity and mortality, as well as being strongly associated with not completing the secondary prevention program (CR) that could benefit those who smoke the most.
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Affiliation(s)
- Diann E Gaalema
- Department of Psychiatry, University of Vermont, Burlington, VT, United States of America
| | - Sherrie Khadanga
- Cardiac Rehabilitation and Prevention, University of Vermont Medical Center, South Burlington, VT, United States of America
| | - Quinn R Pack
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School - Baystate, Springfield, MA, United States of America
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Kathuria H, Shankar D, Cobb V, Newman J, Bulekova K, Werntz S, Borrelli B. Integrating Social Determinants of Health With Tobacco Treatment for Individuals With Opioid Use Disorder: Feasibility and Acceptability Study of Delivery Through Text Messaging. JMIR Form Res 2022; 6:e36919. [PMID: 36048509 PMCID: PMC9478816 DOI: 10.2196/36919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/17/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Individuals with opioid use disorder (OUD) have a high prevalence of smoking and frequently experience unmet social determinants of health (SDOH), which may be barriers to smoking cessation. Hospitalization is an opportunity to encourage smoking cessation. Unfortunately, many clinicians do not provide tobacco treatment to support the maintenance of cessation achieved during hospitalization. Interventions are required to support these high-risk individuals after hospital discharge. Objective This study aimed to test the feasibility and acceptability of a 28-day SMS text messaging program tailored to individuals with OUD, which provides smoking cessation support and addresses unmet SDOH needs. Methods From July to December 2019, we enrolled 25 individuals who were hospitalized with tobacco dependence and OUD at our large safety net hospital. The SMS text messaging program was initiated during hospitalization and continued for 28 days. Participants were enrolled in either the ready to quit within 30 days or the not ready to quit within 30 days program based on their readiness to quit. Automated SMS text messages were sent twice daily for 4 weeks. The topics included health and cost benefits of quitting, both general and opioid specific (16 messages); managing mood and stress (8 messages); motivation, coping strategies, and encouragement (18 messages); addressing medication misconceptions (5 messages); links to resources to address substance use (2 messages providing links to the Massachusetts Substance Use Helpline and Boston Medical Center resources), tobacco dependence (1 message providing a link to the Massachusetts Quitline), and unmet SDOH needs (6 messages assessing SDOH needs with links to resources if unmet SDOH needs were identified). Questionnaires and interviews were conducted at baseline and at 2 and 4 weeks after enrollment. Results The participants were 56% (14/25) female, 36% (9/25) African American, 92% (23/25) unemployed, and 96% (24/25) Medicaid insured. Approximately 84% (21/25) activated the program, and none of the participants unsubscribed. Approximately 57% (12/21) completed either the 2- or 4-week questionnaires. Program satisfaction was high (overall mean 6.7, SD 0.8, range 1-7). Many perceived that the SMS text messaging program provided social support, companionship, and motivation to stop smoking. Messages about the health benefits of quitting were well received, whereas messages on how quitting cigarettes may prevent relapse from other substances had mixed views, highlighting the importance of tailoring interventions to patient preferences. Conclusions SMS text messaging to promote smoking cessation and address SDOH needs may be an effective tool for improving quit rates and health outcomes in individuals with tobacco dependence and OUD. Our study adds to the growing body of evidence that SMS text messaging approaches are feasible and acceptable for providing tobacco treatment to all individuals who smoke, even among low-income populations who have OUD and are not ready to quit.
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Affiliation(s)
- Hasmeena Kathuria
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States
| | - Divya Shankar
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States
| | - Vinson Cobb
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States
| | - Julia Newman
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States
| | | | | | - Belinda Borrelli
- Henry M Goldman School of Dental Medicine, Boston University, Boston, MA, United States
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Trapskin PJ, Sheehy A, Creswell PD, McCarthy DE, Skora A, Adsit RT, Rose AE, Bishop C, Bugg J, Iglar E, Zehner ME, Shirley D, Williams BS, Hood AJ, McElray K, Baker TB, Fiore MC. Development of a Pharmacist-Led Opt-Out Cessation Treatment Protocol for Combustible Tobacco Smoking Within Inpatient Settings. Hosp Pharm 2022; 57:167-175. [PMID: 35521012 PMCID: PMC9065528 DOI: 10.1177/0018578721999809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: Although people who smoke cigarettes are overrepresented among hospital inpatients, few are connected with smoking cessation treatment during their hospitalization. Training, accountability for medication use, and monitoring of all patients position pharmacists well to deliver cessation interventions to all hospitalized patients who smoke. Methods: A large Midwestern University hospital implemented a pharmacist-led smoking cessation intervention. A delegation protocol for hospital pharmacy inpatients who smoked cigarettes gave hospital pharmacists the authority to order nicotine replacement therapy (NRT) during hospitalization and upon discharge, and for referral to the Wisconsin Tobacco Quit Line (WTQL) at discharge. Eligible patients received the smoking cessation intervention unless they actively refused (ie, "opt-out"). The program was pilot tested in phases, with pharmacist feedback between phases, and then implemented hospital-wide. Interviews, surveys, and informal mechanisms identified ways to improve implementation and workflows. Results: Feedback from pharmacists led to changes that improved workflow, training and patient education materials, and enhanced adoption and reach. Refining implementation strategies across pilot phases increased the percentage of eligible smokers offered pharmacist-delivered cessation support from 37% to 76%, prescribed NRT from 2% to 44%, and referred to the WTQL from 3% to 32%. Conclusion: Hospitalizations provide an ideal opportunity for patients to make a tobacco quit attempt, and pharmacists can capitalize on this opportunity by integrating smoking cessation treatment into existing inpatient medication reconciliation workflows. Pharmacist-led implementation strategies developed in this study may be applicable in other inpatient settings.
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Affiliation(s)
- Philip J. Trapskin
- University of Wisconsin, Madison, WI, USA,UW Health, Madison, WI, USA,UW School of Pharmacy, Madison, WI, USA
| | - Ann Sheehy
- University of Wisconsin, Madison, WI, USA,UW Health, Madison, WI, USA,UW Department of Medicine, Madison, WI, USA,UW School of Medicine and Public Health, Madison, WI, USA
| | - Paul D. Creswell
- University of Wisconsin, Madison, WI, USA,UW Department of Medicine, Madison, WI, USA,UW School of Medicine and Public Health, Madison, WI, USA,UW Center for Tobacco Research and Intervention (UW-CTRI), Madison, WI, USA,Paul D. Creswell, UW Center for Tobacco Research and Intervention (UW-CTRI), 1930 Monroe Street, Suite 200, Madison, WI 53706, USA.
| | - Danielle E. McCarthy
- University of Wisconsin, Madison, WI, USA,UW Health, Madison, WI, USA,UW Department of Medicine, Madison, WI, USA,UW School of Medicine and Public Health, Madison, WI, USA,UW Center for Tobacco Research and Intervention (UW-CTRI), Madison, WI, USA
| | - Amy Skora
- University of Wisconsin, Madison, WI, USA,UW Department of Medicine, Madison, WI, USA,UW School of Medicine and Public Health, Madison, WI, USA,UW Center for Tobacco Research and Intervention (UW-CTRI), Madison, WI, USA
| | - Rob T. Adsit
- University of Wisconsin, Madison, WI, USA,UW Department of Medicine, Madison, WI, USA,UW School of Medicine and Public Health, Madison, WI, USA,UW Center for Tobacco Research and Intervention (UW-CTRI), Madison, WI, USA
| | - Anne E. Rose
- University of Wisconsin, Madison, WI, USA,UW Health, Madison, WI, USA,UW School of Pharmacy, Madison, WI, USA
| | - Candace Bishop
- University of Wisconsin, Madison, WI, USA,UW Health, Madison, WI, USA,UW School of Pharmacy, Madison, WI, USA
| | - Jessica Bugg
- University of Wisconsin, Madison, WI, USA,UW Health, Madison, WI, USA,UW School of Pharmacy, Madison, WI, USA
| | - Emily Iglar
- University of Wisconsin, Madison, WI, USA,UW Health, Madison, WI, USA,UW School of Pharmacy, Madison, WI, USA
| | - Mark E. Zehner
- University of Wisconsin, Madison, WI, USA,UW Department of Medicine, Madison, WI, USA,UW School of Medicine and Public Health, Madison, WI, USA,UW Center for Tobacco Research and Intervention (UW-CTRI), Madison, WI, USA
| | - Daniel Shirley
- University of Wisconsin, Madison, WI, USA,UW Health, Madison, WI, USA,UW School of Medicine and Public Health, Madison, WI, USA
| | - Brian S. Williams
- University of Wisconsin, Madison, WI, USA,UW Health, Madison, WI, USA,UW Department of Medicine, Madison, WI, USA,UW School of Medicine and Public Health, Madison, WI, USA,UW Center for Tobacco Research and Intervention (UW-CTRI), Madison, WI, USA
| | - Adam J. Hood
- University of Wisconsin, Madison, WI, USA,UW School of Pharmacy, Madison, WI, USA
| | - Krista McElray
- University of Wisconsin, Madison, WI, USA,UW Health, Madison, WI, USA,UW School of Pharmacy, Madison, WI, USA
| | - Timothy B. Baker
- University of Wisconsin, Madison, WI, USA,UW Department of Medicine, Madison, WI, USA,UW School of Medicine and Public Health, Madison, WI, USA,UW Center for Tobacco Research and Intervention (UW-CTRI), Madison, WI, USA
| | - Michael C. Fiore
- University of Wisconsin, Madison, WI, USA,UW Health, Madison, WI, USA,UW Department of Medicine, Madison, WI, USA,UW School of Medicine and Public Health, Madison, WI, USA,UW Center for Tobacco Research and Intervention (UW-CTRI), Madison, WI, USA
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Kathuria H, Herbst N, Seth B, Clark K, Helm ED, Zhang M, O’Donnell C, Fitzgerald C, Itchapurapu IS, Waite M, Wong C, Swamy L, Olson J, Mishuris RG, Wiener RS. Rapid Cycle Evaluation and Adaptation of an Inpatient Tobacco Treatment Service at a U.S. Safety-Net Hospital. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211041295. [PMID: 37089992 PMCID: PMC9981890 DOI: 10.1177/26334895211041295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background To address disparities in smoking rates, our safety-net hospital implemented an inpatient tobacco treatment intervention: an “opt-out” electronic health record (EHR)-based Best Practice Alert + order-set, which triggers consultation to a Tobacco Treatment Consult (TTC) service for all hospitalized patients who smoke cigarettes. We report on development, implementation, and adaptation of the intervention, informed by a pre-implementation needs assessment and two rapid-cycle evaluations guided by the Consolidated Framework for Implementation Research (CFIR) and Expert Recommendations for Implementing Change (ERIC) compilation. Methods We identified stakeholders affected by implementation and conducted a local needs assessment starting 6 months-pre-launch. We then conducted two rapid-cycle evaluations during the first 6 months post-implementation. The CFIR informed survey and interview guide development, data collection, assessment of barriers and facilitators, and selection of ERIC strategies to implement and adapt the intervention. Results Key themes were: (1) Understanding the hospital's priority to improving tobacco performance metrics was critical in gaining leadership buy-in (CFIR Domain: Outer setting; Construct: External Policy and Incentives). (2) CFIR-based rapid-cycle evaluations allowed us to recognize implementation challenges early and select ERIC strategies clustering into 3 broad categories (conducting needs assessment; developing stakeholder relationships; training and educating stakeholders) to make real-time adaptations, creating an acceptable clinical workflow. (3) Minimizing clinician burden allowed the successful implementation of the TTC service. (4) Demonstrating improved 6-month quit rates and tobacco performance metrics were key to sustaining the program. Conclusions Rapid-cycle evaluations to gather pre-implementation and early-implementation data, focusing on modifiable barriers and facilitators, allowed us to develop and refine the intervention to improve acceptability, adoption, and sustainability, enabling us to improve tobacco performance metrics in a short timeline. Future directions include spreading rapid-cycle evaluations to promote implementation of inpatient tobacco treatment programs to other settings and assessing long-term sustainability and return on investment of these programs.
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Affiliation(s)
- Hasmeena Kathuria
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - Nicole Herbst
- Division of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Bhavna Seth
- Division of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kristopher Clark
- Division of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Eric D. Helm
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - Michelle Zhang
- Division of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Charles O’Donnell
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - Carmel Fitzgerald
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | | | - Meg Waite
- Analytics and Public Reporting, Boston Medical Center, Boston, MA, USA
| | - Carolina Wong
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - Lakshmana Swamy
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - Jen Olson
- Epic Patient Access Systems, ITS, Boston Medical Center, Boston, MA, USA
| | - Rebecca G. Mishuris
- Division of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Renda Soylemez Wiener
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, USA
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Williams BS, Smith SS, Marbin JN, Huang MZ, Garell CL, Kosack AS, Shaikh U, Tebb KP, Fiore MC. Addressing Environmental Smoke Exposure During Pediatric Hospitalization: Attitudes and Practices of Pediatric Nurses Versus Respiratory Therapists. Respir Care 2021; 66:275-280. [PMID: 32962999 PMCID: PMC9994221 DOI: 10.4187/respcare.08038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Tobacco smoke exposure leads to numerous adverse health effects in children. Providing cessation interventions to caregivers who smoke during pediatric hospitalizations can help protect children from such exposure. Both pediatric registered nurses (RNs) and pediatric respiratory therapists (RTs) are well positioned to provide these interventions. Little is known about their rates of participation in cessation efforts. Our objective was to compare the attitudes and practice of pediatric RNs versus pediatric RTs to evaluate their relative cessation-intervention practices in the in-patient pediatric setting. METHODS An online survey was sent to pediatric RNs and RTs at 4 tertiary pediatric hospitals in California. The survey assessed individual demographics, work environment, experience, beliefs, and practices related to smoking cessation activities. Questions used 3-point and 5-point Likert scales and were compared with the chi-square test. Institutions with a response rate < 20% were excluded. RESULTS A total of 401 respondents were included in the final analysis (292 RNs, 109 RTs). RTs versus RNs were older (42.0 y vs 35.4 y, respectively, P < .001) and more likely to be former smokers (29.9% vs 13.3%, respectively, P < .001). RNs reported lower levels of confidence in discussing smoking cessation with parents, with 11.7% saying they felt "very confident" compared to 29.0% of RTs (P < .001). RNs also reported screening for smoke exposure less frequently than RTs, with 18.8% responding "often" or "always" compared to 28.9% of RTs (P = .033). RNs had lower rates of advising parents "to make a smoke-free home policy" compared to RTs (ie, 13.4% vs 26.9%, respectively, P = .002). CONCLUSIONS Compared to in-patient pediatric RNs, RTs reported higher rates of confidence in providing cessation interventions, screening for smoke exposure, and counseling on reducing smoke exposure, suggesting that they may be better positioned for intervening. These results can inform the design of an in-patient cessation intervention for caregivers of hospitalized children.
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Affiliation(s)
- Brian S Williams
- Department of Pediatrics and Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | - Stevens S Smith
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jyothi N Marbin
- Department of Pediatrics, UCSF School of Medicine, San Francisco, California
| | - Maria Z Huang
- Department of Pediatrics, UC-San Diego School of Medicine, San Diego, California
| | - Cambria L Garell
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Amanda S Kosack
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ulfat Shaikh
- Department of Pediatrics, UC-Davis School of Medicine, Sacramento, California
| | - Kathleen P Tebb
- Department of Pediatrics, UCSF School of Medicine, San Francisco, California
| | - Michael C Fiore
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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6
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Gonzales D, Bjornson WG, Markin CJ, Coleman TM, Favela F, Clemons N, Koudelka C, Lapidus JA. Improving Smoking Cessation Outcomes Through Tailored-Risk Patient Messages at a University Hospital Tobacco Cessation Service. Jt Comm J Qual Patient Saf 2020; 46:250-260. [PMID: 32362354 DOI: 10.1016/j.jcjq.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/02/2020] [Accepted: 02/11/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Postdischarge follow-up is a critical step for increasing effectiveness of hospital smoking cessation treatment. A quality improvement project was undertaken at an academic medical center tobacco cessation consult service to evaluate whether a tailored message (TM) linking immediate risks of continued smoking-particularly carbon monoxide exposure-to hospital recovery would stimulate more patient interest in the hospital's cessation treatment, including agreement to postdischarge follow-up, compared to patients receiving the usual treatment protocol with a standard message (SM) regarding more general health benefits of abstinence. METHODS Data from 697 smokers ordered/referred for smoking cessation treatment in 2013 who received either the SM (January-April; n = 323) or the TM (April-November; n =374) were analyzed. RESULTS Multivariate regression analysis showed that the TM was associated with significantly greater agreement for follow-up (odds ratio [OR] = 10.83, 95% confidence interval [CI] = 3.66-32.04, p < 0.0001) than the SM. Those patients who received the TM were more willing to try to remain abstinent postdischarge (willingness score = 10, p = 0.0052) and engaged in longer consults (consult time > 10 minutes, p = 0.0075) than SM patients. TM patients also self-reported a higher continuous abstinence rate (OR = 2.07, 95% CI = 1.17-3.66, p = 0.0130] at follow-up than SM. CONCLUSION Linking risks of continued smoking, particularly carbon monoxide exposure, to hospital patients' immediate recovery following discharge in a treatment protocol resulted in longer consult times and increased agreement to follow-up compared to the usual protocol message. The TM was integrated into the hospital tobacco cessation intervention as standard of care.
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Feasibility, Acceptability, and Adoption of an Inpatient Tobacco Treatment Service at a Safety-Net Hospital: A Mixed-Methods Study. Ann Am Thorac Soc 2020; 17:63-71. [DOI: 10.1513/annalsats.201906-424oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Pack QR, Priya A, Lagu TC, Pekow PS, Atreya A, Rigotti NA, Lindenauer PK. Short-Term Safety of Nicotine Replacement in Smokers Hospitalized With Coronary Heart Disease. J Am Heart Assoc 2019; 7:e009424. [PMID: 30371184 PMCID: PMC6222950 DOI: 10.1161/jaha.118.009424] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Little is known about the safety of nicotine replacement therapy (NRT) in smokers hospitalized with coronary heart disease. Methods and Results We examined the short‐term safety of NRT use among smokers hospitalized for coronary heart disease in a geographically and structurally diverse sample of US hospitals in the year 2014. We compared smokers who started NRT in the first 2 days of hospitalization with smokers without any exposure to NRT and adjusted for baseline differences through propensity score matching. Outcomes included inpatient mortality, hospital length of stay, and 1‐month readmission. From 270 hospitals, we included 27 459 smokers (mean age, 58 years; 69% men; 56.9% in intensive care unit), of whom 4885 (17.8%) received NRT (97.2% used the nicotine patch, at a median dose of 21 mg/d for 3 days). After propensity matching, covariates were well balanced within each patient group. Among patients with myocardial infarction, compared with patients who did not receive NRT, those who received NRT showed no difference in mortality (2.1% versus 2.3%; P=0.98), mean length of stay (4.4±3.5 versus 4.3±3.3 days; P=0.60), or 1‐month readmission (15.8% versus 14.6%; P=0.31). Results were similar for patients undergoing percutaneous coronary intervention or coronary artery bypass surgery. Conclusions Among smokers hospitalized for treatment of coronary heart disease, use of NRT was not associated with any differences in short‐term outcomes. Given the known beneficial effects of NRT in treating nicotine withdrawal, reducing cravings, and promoting smoking cessation after discharge, our findings suggest that NRT is a safe and reasonable treatment option.
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Affiliation(s)
- Quinn R Pack
- 1 Division of Cardiovascular Medicine Baystate Medical Center Springfield MA.,2 Department of Internal Medicine Baystate Medical Center Springfield MA.,3 Institute for Healthcare Delivery and Population Science Springfield MA.,4 University of Massachusetts Medical School at Baystate Springfield MA
| | - Aruna Priya
- 3 Institute for Healthcare Delivery and Population Science Springfield MA
| | - Tara C Lagu
- 2 Department of Internal Medicine Baystate Medical Center Springfield MA.,3 Institute for Healthcare Delivery and Population Science Springfield MA.,4 University of Massachusetts Medical School at Baystate Springfield MA.,5 Department of Quantitative Health Science University of Massachusetts Medical School Worcester MA
| | - Penelope S Pekow
- 3 Institute for Healthcare Delivery and Population Science Springfield MA.,6 School of Public Health and Health Sciences University of Massachusetts Amherst MA
| | - Auras Atreya
- 1 Division of Cardiovascular Medicine Baystate Medical Center Springfield MA.,2 Department of Internal Medicine Baystate Medical Center Springfield MA
| | - Nancy A Rigotti
- 7 Department of Medicine Tobacco Research and Treatment Center Massachusetts General Hospital and Harvard Medical School Boston MA
| | - Peter K Lindenauer
- 2 Department of Internal Medicine Baystate Medical Center Springfield MA.,3 Institute for Healthcare Delivery and Population Science Springfield MA.,4 University of Massachusetts Medical School at Baystate Springfield MA.,5 Department of Quantitative Health Science University of Massachusetts Medical School Worcester MA
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Kathuria H, Seibert RG, Cobb V, Herbst N, Weinstein ZM, Gowarty M, Jhunjhunwala R, Helm ED, Wiener RS. Perceived barriers to quitting cigarettes among hospitalized smokers with substance use disorders: A mixed methods study. Addict Behav 2019; 95:41-48. [PMID: 30836208 DOI: 10.1016/j.addbeh.2019.02.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 02/16/2019] [Accepted: 02/17/2019] [Indexed: 12/25/2022]
Abstract
AIMS Smoking cessation may promote long-term recovery in patients with substance use disorders (SUD). Yet smoking rates remain alarmingly high in this population. Using a sequential explanatory mixed methods approach, we examined smoking rates among hospitalized patients with SUD at a large safety-net hospital, and then characterized factors associated with smoking behaviors both quantitatively and qualitatively. METHOD We abstracted data from all hospital admissions (7/2016-6/2017) and determined demographics, substance use type, and other characteristics associated with cigarette use among those with SUD. We then conducted semi-structured qualitative interviews with 20 hospitalized SUD smokers. We analyzed transcripts to characterize factors that affect patients' smoking habits, focusing on the constructs of the Health Belief Model. RESULTS The prevalence of cigarette smoking among hospitalized smokers with SUD was three times higher than those without SUD. Qualitative analyses showed that patients perceived that smoking cigarettes was a less serious concern than other substances. Some patients feared that quitting cigarettes could negatively impact their recovery and perceived that clinicians do not prioritize treating tobacco dependence. Almost all patients with heroin use disorder described how cigarette use potentiated their heroin high. Many SUD patients are turning to vaping and e-cigarettes to quit smoking. CONCLUSION Hospitalized patients with SUD have disproportionately high smoking rates and perceive multiple barriers to quitting cigarettes. When designing and implementing smoking cessation interventions for hospitalized patients with SUD, policymakers should understand and take into account how patients with SUD perceive smoking-related health risks and how that influences their decision to quit smoking.
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Affiliation(s)
- Hasmeena Kathuria
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States of America.
| | - Ryan G Seibert
- Division of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States of America
| | - Vinson Cobb
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States of America
| | - Nicole Herbst
- Division of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States of America
| | - Zoe M Weinstein
- Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, Boston, MA, United States of America
| | - Minda Gowarty
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States of America
| | - Reha Jhunjhunwala
- Program of Clinical Investigation, Boston University School of Medicine, Boston, MA, United States of America
| | - Eric D Helm
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States of America
| | - Renda Soylemez Wiener
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States of America; Center for Healthcare Organization & Implementation Research, ENRM VA Hospital, Bedford, MA, United States of America
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Hawari FI, Obeidat NA, Rimawi D, Jamal K. Smoking cessation care can translate to lower hazard of death in the short-run in cancer patients - a retrospective cohort study to demonstrate the value of smoking cessation services within the treatment phase of cancer. BMC Cancer 2019; 19:580. [PMID: 31256763 PMCID: PMC6600880 DOI: 10.1186/s12885-019-5778-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 05/30/2019] [Indexed: 01/04/2023] Open
Abstract
Background Smoking cessation is a key step towards improving cancer care and outcomes. However, smoking cessation interventions are underprovided in oncology settings. Within Jordan’s only comprehensive oncology center, we sought to evaluate receipt of care at a smoking cessation clinic and the effect of assisted abstinence through the smoking cessation clinic on short-term (two-year) survival after a cancer diagnosis. Methods We employed a retrospective cohort study design. Cancer registry and smoking cessation clinic data for adult Jordanian cancer patients diagnosed between 2009 and 2016, who also were cigarette smokers, and who received full treatment at King Hussein Cancer Center, were analyzed. Specifically, descriptive statistics of patients who visited the smoking cessation clinic were generated, and short-term (two-year) hazard of death of patients based on whether or not smoking cessation clinic-assisted abstinence occurred, were evaluated. Results There were 3403 patients who met our inclusion criteria. Approximately 21% of cancer patients were seen at the smoking cessation clinic, and significant demographic and clinical disparities in who was being seen [at the smoking cessation clinic] existed. In 2387 patients with available survival data, smokers who never went to the smoking cessation clinic (or were seen only once, or seen a year or more from diagnosis) had a hazard of death 2.8 times higher than smokers who had visited the smoking cessation clinic and who also confirmed they had not smoked on atleast two of their 3-, 6- or 12-month follow-up visits (95% confidence interval [CI] = 1.7–4.6). Non-abstainers at the smoking cessation clinic exhibited a similar disadvantage (HR 2.7, 95% CI 1.4–5.0). Conclusions Although evidence-based smoking cessation interventions increase the likelihood of abstinence and can lower the short-term hazard of death during cancer treatment, there is a deprioritization of smoking cessation interventions during cancer care, as indicated by low proportions of patients seen at the smoking cessation clinic. Our findings emphasize the importance of promoting interventions to avail smoking cessation interventions in oncology settings within the cancer treatment phase.
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Affiliation(s)
- F I Hawari
- Section of Pulmonary and Critical Care, Department of Medicine, King Hussein Cancer Center, P.O. Box 1269, Queen Rania Al Abdullah Street, Amman, Al-Jubeiha, 11941, Jordan. .,Cancer Control Office, King Hussein Cancer Center
- , Amman, Jordan.
| | - N A Obeidat
- Cancer Control Office, King Hussein Cancer Center
- , Amman, Jordan
| | - D Rimawi
- Office of Scientific Affairs - Center of Research Shared Resources, King Hussein Cancer Center, Amman, Jordan
| | - K Jamal
- Office of Scientific Affairs - Cancer Registry, King Hussein Cancer Center, Amman, Jordan
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11
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Pack QR, Priya A, Lagu TC, Pekow PS, Rigotti NA, Lindenauer PK. Smoking Cessation Pharmacotherapy Among Smokers Hospitalized for Coronary Heart Disease. JAMA Intern Med 2017; 177:1525-1527. [PMID: 28828485 PMCID: PMC5820688 DOI: 10.1001/jamainternmed.2017.3489] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study uses data from the Premier Alliance database to assess factors associated with the use of smoking cessation pharmacotherapy in smokers hospitalized for coronary heart disease.
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Affiliation(s)
- Quinn R Pack
- Division of Cardiovascular Medicine, Baystate Medical Center, Springfield, Massachusetts.,Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.,Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Aruna Priya
- Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
| | - Tara C Lagu
- Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.,Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Penelope S Pekow
- Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts.,Department of Biostatistics, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Peter K Lindenauer
- Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.,Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
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